Book reviews

The book 'Sehtibungen, ein Bilderbuch" provides a variety of exercises for children in the agegroup of five to eight years with strabismus or other conditions causing reduced visual acuity. The illustrations from yesterday are black and white and of high contrast. They contain a lot of fine details and are likely to catch the interest of a child for a while. As the instructions are clear and easily understood the book should be possible to use in cases where the instructor's knowledge of German is

crease in a regular series; and, by such means, we should judge, from comparative estimates, whether nature were performing her functions in due course, or whether there were some impediments or interruptions to healthy accretion. The chapter in which these calculations and observations are met with, is terminated by the following division of the period of infancy into three epochs. u The first, which commences at birth, and terminates about the 8ixth month, seems to be principally destined for suction and simple respiration. In this epoch is especially to be noticed a predominance of fluids over the solid part of the system, of lymphatics over blood-vessels, and of cellular substance above muscular fibre. The head is large, the heart bears a proportion to the body of eight to one over the adult state, the pulse beats from 120 to 140 in a minute, the senses and the understanding seem to be in a state of inactivity, and sleep is the principal want of life. " The second epoch, more complicated and active (plus orageuse), commences with the process of teething, at about the seventh month. At this period begins the necessity for a new kind and mode of nourishment; and the developement of corporeal powers invites likewise to something more of energetic exercise. This is the epoch of the principal derangement of functions; and feverish irritations arc now very common attendants on the teething process, by which the several maladies incident to the state of childhood arc rendered more severe in their nature, and malignani in their aspect.
"From the time of dentition to the period of puberty, we do not meet with any particularly-marked interruption in the general progress of development. It may be necessary, however, just to notice the second teething, which takes place about the seventh year, and which, although not, for the most part, attended with much irritation of the frame, has, nevertheless, some influence over 222 Critical Analysis, over its physical character. Between the first and second denti* tion,. the efforts of the system are mainly directed towards the completion of the general functions; the digestion gradually accustoms itself to variety of aliment, the chest becomes expanded, the organs of smell and several parts of the countenance develop themselves, the cartilages are ossified, and new actions take place throughout the whole body; the arterial pulsations are reduced to 80 or 90 in a minute, and in the same proportion is augmented the power of the muscular fibre ; the brain approaches much nearer to the adult size; and the animal spirits become, in some measure, subordinate to the voluntary power. Almost all the diseases incident to our earlier years make their appearance and exit during this interval, such as the tinea-capitis, eruptive affections behind the ears, worms, rickets, measles, and small-pox. It is not until after the seventh year, and when the second set of teeth have made their appearance, that the digestive powers show themselves equal to a more substantial nutriment, that the lungs take on the adult colour, and that the male voice becomes a little more characteristic; the sutures of the cranial bones now form, the chin increases in size, the physiognomy acquires somewhat of character, and the parent, or instructor, begins to have some influence over the senses and the intellectual faculties." P. 45-8. The third chapter need not detain us long, [t principally consists of directions respecting the best substitutions of food for the mothers' milk, when that cannot he obtained ; and of general rules in reference to nursing. We here meet ivith a compliment to English mothers, as it relates to the management of their infants. French nursing has in it, he says, too much of tendency to a premature excitation of vivacity, while the German system, on the contrary, proceeds too much upon the plan of quieting and unduly curbing the animal spirits. Dr. Friedlander is an enemy to abrupt weaning. He thinks, that the process should commence even from the third month, and, in the general way, not be completed till between the seventh and ninth, about the period of dentition. He is rather unfriendly to the plan of cutting upon the teeth, in order to assist their development, and kissen the irritation occasioned by difficult dentition. " For the most part (he says) it is best not to interfere with the operations of nature." This doctrine, however, carried to an extreme, would go to the prevention of any artificial assistance in maladies in general, and would be fatal to the pretensions of the medical art. In reference to the question of incision, in cases of difficult dentition, we would say that it ought not to be done too early, or for every trivial irritation; but that, when the incision is made, it ought to be much more freely and deeper than is generally practised. The objection may be valid to an early and frequent J)e VEducation Physique de l'Homme. 22$ frequent cutting of the gum, that it is apt to leave cicatrices, and thus increase the evil it is intended to lessen. ' In the fifth division of his work, the author enters into a more minute detail respecting the chemical composition, and nutritive qualities, of the different aliments that are used, either directly or indirectly, for the sustenance of infants. We meet again here with a little more nicety in the way of calculation and statement of elementally proportions, than: we are accustomed to find in this country in practical works; but, deducting something from the merit of the treatise before us, on the score of its being rather too much tincturedwith Gallic or German particularities, we find in this, as many other parts, much that is applicable and instructive.: Our limits will not allow us more in the way of extract tharr an abridgment of the statement which th6 author introduces at the end of this chapter, of the progress of man, from his Original condition of savage simplicity, to that of civilization and complicated wants.
In the state of nature, the mother suckles her infant for. a considerable time. She afterwards nourishes it with the vegetable and animal products of the land, rudely prepared for aliment.
Man, in this condition, is not pampered by variety ; his digestion is active, his exercises violent. Agriculture soon follows the more simple state of nature. The peasant, however, retains a simplicity in his diet, an uniformity in his habits of life. He has scarcely any call but for the exertion of his animal strength, and his existence is but a small remove from the savage.
But families shortly increase;?the village becomes a town, the town is converted into a city. Individuals leave their native places in search of fortuue and now the intellectual faculties are called into exercise, and assert their superiority over mere bodily strength. In this new and complicated condition of existence, different parts of the human frame are, as it were, put into requisition at the expense of the Test. One calling requires the exertion of the lungs, another more particularly of the head, while, in some again, the muscles are almost solely employed. Under these circumstances infants are born, and while they bring into the world with them the irregularities, defects, and, in some respects, the approach to greater perfection, of their parents, they are, of course, subjected to tho same mode of sustenance, and the same general habits." The evils and remedies of social and civilized life are pursued in this manner, through a considerable extent of detail. Our author all along is full of very pleasing anticipations respecting the eventual mastery of intellect in this content, as it ?24 Critical Analysis.
. * ? it were, between the external ills to which man is exposed, and the resources for their counteraction with which he finds himself furnished. He is not, indeed, a disciple of that doctrine which teaches the absolute perfectibility of man in his moral and physical nature, but he thinks that what has already been effected by science, warrants a very favourable inference in respect of what yet remains to be accomplished. Oil the subject of contagions, we meet with the following observations and statements. il Besides the constant and inevitable influence of seasons, we are exposed likewise to some other causes of distempers which remain to be noticed, namely, particular contagions> which affect the system either through the medium of the lungs or the skin; these are either derived from a-far, and brought to us by the winds, are conveyed from a distance by bodies who have been infected; with them from contact, or we receive them by actual and immediate communication with infected individuals. These contagions, often produce the necessity of complete isolation. Venice, for example, during the time that she was in the possession of the Levant' trade, established quarantine laws in order to prevent the introduction of the plague by means of imported' cotton. In the seventeenth century, Paris was visited with this malady, and it became necessary to convoy the infected, without exception, into houses at a distance from the city, and to forbid their communication with others ; and, when Europe'some years since was mcnaccd with the yellow fever, plans'of prevention were likewise put.in pr&cticc.
In regard to the contagion of smdll.pox, quarantine laws were' never thought of. This poison at one tithe occasioned the deatli of one in seven of the whole population of London; at a later period, the proportions came to be about one iu ten or thirteen.
After the practice of inoculation, at the commencement of the last century, was introduced into Europe from Turkey, and when the most favourable time and circumstanccs were chosen for the operation, the deaths were not more than one in four or five hundred, of those who wert inlected in this way. Notwithstanding which, thd general mortality from the distemper was not diminished, as there Were no laws in force for isolating the subjects of inoculation. Englatid lost at least 21,000 every year, out of a population of a little more than 9,000,000; and it was calculated that the annual deaths in Europe, from small-pox alone, was 400,000. After the introduction of vaccination, the police of Copenhagen obliged all its subjects to have recourse to it, and to separate entirely those children' from any communication with others, who by any accident had taken the small-pox; during the space of one whole year, thCrs was but one instance subsequent to this regulation of death from' small.pox. This measure has accordingly been adopted since in several of the Germanic states, and among others in Prussia, a country in which the medical police always meets.with great facilities in its operations. Cut the circumstances of the recent wars: have fie. ? Education Physique de t Homme. 225 lure often interrupted the execution of these plans, so salutary'to the general population. " AHbough England gave birth to the discovery of vaccination, the practicedid not become general in London until the year 1803.
According to a census of deaths from small-pox, from the year. 1788 to 1797 inclusive; the numbers were found 18,538. From 1803 to the end of 1812 the deaths were only 11,532, which is a diminution of 700G. In 1813, only S9S died, which is a fourth less than the preceding year. -A committee exists in that country for the distribution of the vaccine virus, and the number of charged glasses (flacons) distributed last year amounted to 25,394. <4 In the last report from the central committee of Paris, an account was communicated of the comparative mortality of those different departments in which vaccination had met with most en-' couragement. At Strasbourg, the deaths in 1803, were 518 from Small.pox; in 1812, only one. In forty-three communes of the department de l'Oise, 13,770 individuals died during the ten years preceding the introduction of the vaccine fluid into France, and in. the subsequent ten years only 10,510, which is a diminution of 32?>0. For this happy result, we are indebted to the noble and.
active exertions of M. le Due de la Rochefoucauld. Three fourths of all the children that were born in 1813, have been vaccinated,, and it has been ascertained that 3,065,000 individuals have been, subjected to vaccination since 1804.
It is remarkable, that in Asia and among the half civilized colonies of Africa a^d America, the people have been more eager for,, or at leust less fearful of the new inoculation than the inhabitants of Europe. The government of the Cape of Good Hope, and that of Ceylon, have already effected the total extinction of the small.pox." Such are the statements of Dr. Friedlander respecting morbid poisons, and his inference from the whole is, that " it ought to be admitted as a part of the physical management ot children, that all those who are affected with any disease which is capable of being communicated to another, should immediately and without reference to circumstances, be separated from other individuals; and, that vaccination,^ the unequivocally good effects of which are eyery day visible, ought never to be neglected." * The next chapter is 011 the subject of exercise; under this division, the author is not less interesting than instructive.
He regards every minute peculiarity of a nation and people as more influential upon, and more intimately connected' with, their moral, physical, and political, condition than is generally suspected. In support of this position we meet with some remarks and facts, which we are sony our limits will not permit us to transcribe. Yet, this again gives scope to that theorizing and system-making enthusiasm, which, though common on the continent, has never been admitted by the more sober philosophers of Great Britain. Every evil is to No. 211. eg disappear Qd{J ? ' Critical Analysis* disappear before the march of intellect, and every thing is eventually to be compassed by the penetration and powers of man.
? ? The parts of the work which treat on the several senses are not of course susceptible of any satisfactory analysis ; suffice it to say, that the reader of the book will find, especially on the subject of the organ of speech; and the general theory of language, a good deal that is pleasing and philosophical, if not very new or profound. Here again we find, X)ik. F. full of sanguine anticipations; he admits, indeed, that the various projects which have hitherto had place fot* the purpose of improving and simplifying language upor^ the principles of sound, have not done much, f? but the; impulse has been given, and it is probable that in no very, distant day, some superior understanding shall find out the means for doing away the obstacles which at present impede the art of pronouncing, when simple rules may be developed of> universal application. Indeed, if we understand, hurre aright, he goes so far as to suppose the time when philosophy shall have annihilated national and local impediments anddisabilities to the expression of certain sounds, such as the Continental th, and the English intermediate something: be- On the subject of stammering, which has recently occupied the attention of several persons in this country, as. well as on the continent, we do not find much of novelty, or of matter capable of any practical application. " Amman (he tells us,) makes stammering individuals practise the pronunciation of the explosive (explosives) syllables, such as par, -pec, tac, toe, tic, &'c." The fact is, that the theory of stammering is inexplicable upon any principles with which we are at present acquainted. When, indeed, we discover any 6rganid malconformations, such as occasion impediments to' the labial and dental sounds, we find 110 difficulty in giving! their explication, atod pointing out their partial remedies; but, when an-actual ihcapacity of pronunciation exists, so that the individual shall only be capable of a kind of spasmodic or convulsive exercise of the organs of speech, without any visible organic defect of structure, it is extremely difficult to attach any decided opinion concerning 'the cause of such defect, and we ave forced to have recourse to the undefined expression of nervous inability. We have, however, recently witnessed a remarkable and almost instantaneous cure of this mulady. The individual case to which we allude is not singular, maiiv others have been treated precisely in the same,manner, anu with the same effect. The process by which the cure is accomplished, is at present a secret, but Vft Medico-ChirurgicaI Transactions.

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Ise trmt it will not long remain so; and when it shall be generally known and acted upon, one example at least will be afforded us in favour of Dr. Friedlander's hopeful expectations.
Such are the outlines of the medical part of Dr. Friedlander's book. In the moral education we cannot be expected to follow him. His two concluding chapters on this head prove him, however, to be a man of sound judgment, united with good taste and correct sentiment; and we do not hesitate recommending to our readers the whole of th? performance. In these days, and in a work intended principally for disr eoveries leading to improvements in practice, we were not prepared for a dissertation of fifty pages on so hacknied a iubject as ligatures on arteries. Nor could we withhold our surprise, when we found the attention of the Medico-Chirurgical Society directed to Ambrose Pare, Poiteau* Petit, Morand, and other French academicians. Still less were we satisfied at seeing the errors of the venerable Pott wantonly brought forward, although we might feel some relief reading the compliments paid to Allison, Hunter, and Jones, yet even these seemed to us equally unnecessary. However, as the mention, of the last-named gentleman introduces Mr. Lawrence's improvements, we shall transcribe that passage, glad, at the same time, of every opportunity to do justice to the illustrious dead.

Jfedico-Chirurgical
surface of the wound, must irritate, must cause inflammation and 'suppuration. In amputations, where it is necessary to secure many vessels, a large portion of the wound is exposed to this irritation ; its union is retarded, and considerable pain and spasm are sometimes produced. Are these evils inseparable from the use of ligatures: or is there any plan by which we can avoid them? I think that there is; and I shall proceed to state to the Society the trials I have made, and the experience which my practice has fur. lushed on this subject. A longer delay would have enabled me to ascertain some points more satisfactorily, and to procure opportunities of trying the method in cases to which I have not yet applied it. But several friends have urged me to make the proposal known ; and I accede to their suggestion the more readily, as it 'may lead others to make trials, and thus enable us sooner to appreciate the value of the proposal. <? The method I have adopted consists in tying the vessels with fine silk ligatures, and cutting off the ends as close to the knot as js consistent with its security. Thus, the foreign matter is reduced to the insignificant quantity which forms the noose actually surrounding the vessel, and the knot by which that noose is fastened. Of the silk which I commonly employ, a portion sufficient to tye a large artery, when the ends are thus cut off, weighs between and of a grain; a similar portion of the thickest kind I have tried weighs of a grain, and of the slenderest T^y. These ligatures do not interfere with the process of adhesion ; and we shall hardly entertain any serious apprehension that substances 350 minute will excite subsequent irritation and disturbance." We know not what inconveniences may have occurred at St. Bartholomew's by the common thin ligature of strongtwine, but, as far as our own experience goes, we have found none, for we cannot call the remaining of the thread for a few days a matter of any consequence. Often have we seen the whole of the integuments instantly unite where enough has been preserved; and the ligature with ease removed by should be paid to symptoms as they demonstrate themselves, Jf he finds marks of inflammation from pain, general intumescence, and tensity, especially with an account of previous high health, his whole business should be to reduce the inflammation, at all events by general, and, if necessary, by topical bleeding; by the latter only will he gain much advantage, when the disease is completely formed. In its more advanced stage, he can only act according to circumstances, and must vary his remedies as the symptoms change ; but, in whatever part of the joint the disease may have originated, or may exist at the time of examination, is fortunately of little importance, as the most of the treatment will not be regulated by it, even could we acquire such knowledge.
Three cases follow of inflammation of the synovial membrane, which are introduced by the following remark: " They show (says Mr. B.) the principal circumstances which ioccur in this disorder, and the varieties to which it is subject. The first affords an instance of inflammation of the synovial membrane in its simplest form, occasioning little else than an effusion of fluid into the articular cavity. In the second, coagulable lymph was effused, in considerable quantity, into the joint; but active treatment having been employed in the beginning of the disease^ before the effused lymph had become organized, it was absorbed, and the knee regained its natural size, and its natural degree of mobility.
The third case is an example of the effects of long.continued and neglected inflammation of the synovial membrane. The joint was permanently swollen, and stiff, in consequence of the synovial membrane having become thickened, and probably from its surfaces beiug encrusted by organised coagulable lymph; and, as always happens under these circumstances, the'patient was liable to a recurrence of the disease from slight causes. This case also Shews how long the synovial membrame may continue inflamed, and how frequently the inflammation may recur without affecting the bones or cartilages of the articulation." On this passage we shall only refer our reader to our last; remark.
Three cases follow in which the cynovial membrane l\ad undergone a morbid alteration of structure. Two of these were cases of the true chronic white swelling, arising from no cause that could be traced, and for which no remedy but amputation could be found. The third appeared the effect of inflammation, which had occurred at different periods: ulceration had taken place, and a small sinus opened superficially. This limb was also amputated.?Cases follow of " ulceration of the articular cartilages." The first of these was ? ' ill Medico-Chirurgical Transactions. 231in the hip, and the patient under a complaint in the bowels, probably a symptom of general hectic. We transcribe the following, and shall venture to offer our opinions. " Mary Anderson;, 28 years of age, was admitted into St. George's Hospital on the 6th of April, 1815.
; " At this time she complained of intense pain in the right knee, ?which was particularly severe at night, so as exceedingly to inter., rupt her rest. Th? pain was referred principally to the head o^ the tibia. There was a slight swelling of the joint, having the form of the articulating ends of the bones, and uot giving to the hand the smallest sense of fluctuation. The leg admitted of being moved on the thigh, b4t all motion aggravated the pain.
" No more particular account of the previous history of the case could be procured than the following ; that she had laboured binder pains of the right knee for nearly six years, which had been occasionally relieved ; and that', in the first instance, the pain had been unattended by swelling.
" Immediately on-her admission, an issue was made, with caustic^ on each side of-the patella. On the 9th of April, the pain had very much abated. The issues were kept open by the occasional application of caustic; and the pains very soon left her, and the swelling diminished-.
" Abont the 8th of June, she began to experience a return of the pains in the knee, and, in the course of four or five days, they were so severe as to keep her awake at night. There were con* vulsive startings of the limb, and the joint was swollen in a greater degree than formerly. The pains increased in violence,; and hei? health began to suffer considerably. On the 3d of July the limb if as. amputated. ,. , . , . , " On examining the. knee, some lymph, and scrum were found effused into the cellular membrane external to it.
" The cavity of the joint contained about half an ounce of thin purulent fluid. The cartilage covering the patella was, in some parts, in a natural state; in others, it had the fibrous structure; and, in others, it was completely destroyed by ulceration, so as tq expose the surface of the bone. The cartilage covering the articulating extremity of the femur presented the same variety of an* pear&nces. On the inside, there was a spot of some extent, whicht instead of cartilage, was covered by an organised substance, resembling the substance of adhesions, but somewhat more dense in its structure, as if the cartilage had been formerly destroyed at this part, aud coagulable lymph had been effused on the ulcerated surface of bone, which had afterwards become organized. " The cartilages of the tibia were ulcerated for a very small extent.
" J'hc synovial membrane, in general, was in a natural state.
In some places, it was slightly inflamed. On the outside of the joint, it was inflamed in a greater degree than elsewhere, and <bickeoed; and had begun to ulcerate, evidently in consequence of the 2SC v Critical Analysis.
the abscess in the joint having begun to make its way to the ear* ternal surface.
" The bones possessed their natural texture and hardness." We confess ourselves at a loss to know why no mention is made of bleeding, either topical or general, when the pains* returned with such severity as to " keep her awake all night." Whether it is that we are grown timid with age, or bold from experience, we should certainly not have urged amputation, without the failure of the above attempts, before the 3d of July, near a month from the beginning of the returning pains. After that time, no wonder if the patient suffered considerably. By the account given of the examination after amputation, Ave can see very little that might not have arisen during the last inflammation.
A few successful cases follow, in some of which bleeding, local or general, was used. In all, issues were made, or caustics 01* blisters applied, and kept open.
Case of Hernia Ventricali, from external Violence, wherein the Diaphragm ? was lacerated without Fracture of the Ribs. By Thomas Wheelwright, Esq. Surgeon. The subject was a German sailor, in the service of this country. In a state of ebriety, he fell from the top of 3 stage-coach; and, complaining of great sickness, was conveyed to St. Thomas's Hospital, but, his ribs not being broken, he was discharged by the house-surgeon, and came under Mr. Wheelwright's care. " At ten o'clock, (says this gentleman,) the following morning, I was desired to see him, and found him under great suffering. He complained of most severe pain in his left side, great difficulty of breathing, violent and continued vomiting, chiefly of blood. Pulse 120, small, tremulous, and irregular; countenance pallid; extremities cold; and temperature of the whole surface of the body below the natural staudard.
By assistance he was raised in the bed, and, upon desiring him to cough, he was unable, as the mere attempt to expand the dhestga'vp him excruciating pain. I satisfied, myself, however, that the ribs were not fractured.
lt By the violent efforts of retching, the bandage had slipt off his arm in the course of the night, and a considerable quantity of blood had flowed from the orifice, about the room and bed-clothes; in addition to which, he had vomited from two to three pints of bloody fluid. From these circumstances, I entertained little doubt that some internal viscus had given way from the fall, and that he was sinking from internal bleeding. I merely directed some aperient medicinc, which his stomach rejected immediately; and a liniment for his side. lie expired the same evening, about eleven " ' o'clock;  o'clock; and the following morning I obtained permission to examine the body. " Disscclion.? On removing the parietes of the abdomen, the viscera were observed to be but little altered from their natural position, and, contrary to my expectation, no blood was extravasated into its cavity. The pyloric extremity of the stomach was confined in an unusual way, and its coats somewhat inflamed. Tha other viscera were in a healthy state. On turning back the sternum, a considerable quantity of blood was found in the left cavity of the chest, which amounted, by measure, to three pints and two ounces. By introducing the hand, a substance appeared attached to the diaphragm, which gave the feeling of a torn portionoflung; but, upon a more minute inspection, it was found to be a considerable part of the-large curvature of the stomach, protruded through a fissure of the diaphragm, and filled with a sort of half coagulated blood. The lung of the same side was much smaller than natural, and occupied the upper and posterior part of the chest, and was strongly adherent in its whole surface ; as was also the case with the right lung. These adhesions were evidently of long standing. Their substance did not appear to have suffered in any proportion with their membranous covering. The heart was of its natural size, and appeared perfectly healthy.
" I was still unable to account from what vessel, or set of vessels, so large a quantity of blood had issued ; but, upon removal of the whole from the body, a small semicircular aperture was observed at the lower part of the thoracic or strangulated portion of the stomach, through which the blood had slowly escaped into the cavity of tha chest; and thus the very gradual increase of difficulty in breathing was accounted for, which, a few hours previous to his death, was so exceedingly distressing. I may further observe, that the fissure in the diaphragm was in the direction from below upwards about an inch in extent, and inclining towards the left side. The stricture was so complete, as with difficulty to allow the points of the little finger to pass. The lower or abdominal portion of the stomach was perfectly empty, as were the intestines generally." This is certainly a very interesting case, and such as we believe is not on record. The author very justly expresses his surprise that the person experienced so little sense of pain for the first twenty-four hours: this may, we conceive, be partly imputed to his ebriety; but even this would hardly account for such insensibility, if the inflammation had actually commenced before that time. The skill and benevolence of Sir Gilbert Blane are too well known to require any encomium frOm us; and we cannot help applauding the perseverance of one who can no longer want fame, in thus bringing before the public such a mass of useful information. We could very much wish it had been contained in a pamphlet by itself, and hope to see it as an appendix to the valuable "Treatise on the Diseases of Seamen." The compilation in which it now appears may be too heavy an expense for those to whom it will be principally useful ; and, much as we admire every part, it must aonear* to those who are not better informed, as if the 2 Society 1Medico-Chirurglcal Transactions. This paper commences with the following paragraph, which we transcribe as a specimen of a pompous mode of delivering a suggestion concerning a fact established more than ten years since, by a most ingenious physician, now, unfortunately, no longer able to maintain his rights.

Sketch of the
If (says Mr. Travers) the arrcstatipn of the column of blood for a time sufficient to admit of its becoming a solid, constituted the security to be rejied upon ; or if, as formerly supposed, the effect of the ligature were confined tq the simple coaptatjon of the sides of the vessel for a time sufficient to induce their adhesion, the propriety of interfering with it might be .questionable. But the facts being established, beyond controversy, that the round ligature divides the inner tunics, and that the wound so produced is healed by a process of adhesive inflammation, it seemed probable" that the serviceable operation of the ligature was limited to a period far short of that, in whiqh its liberation from the vessel by an ulcerative process could be accomplished." We need hardly refer our readers to Dr. Jones's most-va* luable experiments, nor to our own long remarks on the same,* from which it would seem, as we then ventured to conjecture, that the probable cause of the obliteration of the* artery, after the division of the jnner coat, is not merely inflammation, ,the effects of which on arteries are very different,f but a condition of the artery, very similar to what Dr. Jones discovered, when its whole thickness was divided in a certain portion of its diameter, if mere inflammation, and the consequent effusion of lymph, were sufficient, we should find such obliteration in all cases of violently-inflamed arteries. Mr. Travers's experiments confirm this ; though his object is to show that Professor Assalini's compressor is inferior to the ligature applied in the manner proposed by Dr. Jones. Had the Professor been acquainted with the result of Dr. Jones's experiments, he would at once have Seen that, for the purpose of obliteration, the ligature must be preferred. Mr. Travers's experiments prove, as we might expect, that the compressor, to produce an obliteration, must be kept on till, by preventing the circulation in the yasa vasorum, a considerable injury is produced in the artery, sometimes amounting to sphacelus of that part which is contained within the forceps. When this is accomplished, the artery is brought into the same state of necessity, to use the language of Mr. Hunter, as when it is divided, and the same process is set up, that is, obliteration, as the only means of preserving life.
If we were to admit, that the effusion is the mere effect of inflammation, we must be aware that the circulation in the vessel is not prevented by this effusion, as is evident from every part of the experiment: 1st, because the condition, and the degree of adhesion, are insufficient of themselves to stop the progress of the circulation at its customary force; and, secondly, because an increased force, which would be the effect of high inflammation, if it existed, is sufficient to Overcome the slight obstruction of the lymph, as was proved ky some of Mr. Travers's experiments. The stagnation of the blood, therefore, could arise from no other cause than a provision made in the economy to preserve the life of the animal, under all the various conditions of injured arteries ; and the small degree of inflammation discovered in the examination is not greater than is met with in every new action, be the final intent what it may. As we know no better ge-* See Lond. Med. and Phys. Journals, vol. xiv. and xv. + See our remarks on Dr, Hodgson's Treatise on Diseased Arteries, &c. Few branches of chemistry have been so sedulously culti* vated in modern times as that which has for its principal object the examination of animal matter ; and, as this must, we hope, lead to a more intimate and correct acquaintance with physiological science and therapeutics, we cannot too earnestly applaud this meritorious perseverance, especially among many of our own countrymen, in all such researches.
Dr. Marcet has here chosen for his subject one of the most intricate of all others, the very commencement of assimilation and growth, whence, we must suppose, all the principles, as well as compound materials, of animal matter are derived, whether the creature be of the carnivorous or herbivorous tribe.
We are fully aware of the numerous difficulties which must ever accompany all such experiments as serve to investigate the most intricate and u wonderful chemical powers of the digestive organs;" the "almost instantaneous conversion of food into albumen, and soon afterwards into fibrine, fatty matter, and red particles, with the constant appearance of certain salts, all these substances bearing certain propo; tions to each other." For these reasons, therefore, and "in the present imperfect state of the inquiry," as Dr. Marcet very properly considers it, we shall make but tew observations upon these experiments and their results.
When it is considered what a vast quantity of phosphate of lime enters into the animal frame, we are rather surprised to find so little notice taken of this ingredient. No efforts seem to have been made to discover either ot the components of this salt, as it is termed by chemists, excepting the small portion of lime left in the residua of chyme, after destructive distillation. This operation was not carried so far in the analysis of chyle, which was only heated .11 a glass tube, while the ch}de was " thoroughly burnt in a platina crucible" We are not apprised of the quantities of chyle which Dr.
Critical Analysis, Dr. Marcct submitted to experiment, nor whether the nine' parts of saline matter, obtained from 1000 of chyle, amounted to grains, or fractional parts of a grain only, and therefore too minute for further examination; for, if this saline matter really admitted of additional inquiry, we must regret that proper means were omitted to obtain more satisfactory results.
It is remarked by Dr. Marcet, that chyle derived from animal food is more prone to become putrid; and ever} that from vegetable food it will enter into the same fermentative process. Now, as phosphuretted hydrogen is invariably evolved on such occasions, we woi^ld suggest this to the consideration of the experimentalist, as the most practical source whence he may prove the existence of either phosphorus or, more probably, its acid, in this important fluid.
The nature of chyle may possibly vary at times in the same animal, even when no change has been made in the food. We draw this inference from a supposition which will be readily admitted, namely, that the process of ossification is unequal; it is more rapid with some animals than with others, and-the deposition of the earthy phosphate very perceptibly accumulates in some young animals, while, probably, in the aged, this secretion has either ceased entirely, or the phosphate is carried off from the system by means peculiar to each species.
The carbonate of ammonia, heavy fixed oil, and some other things, evolved, are evidently not educts from chyle, but products arising from decomposition. The source from whence the iron is cjerived cannot be so easily ascertained in any of the cases described ; nor that of the alkaline muriate, found in the chyme of the turkey which had fed upon vegetable food only.
Upon the whole, we hope to see these researches continued, and perfectly agree with Dr. Marcet in trusting, *' that our more enlarged views of chemistry, and our improved methods of cultivating that science, will soon throw new light upon this important part of physiology." At the end of the volume is a note, by the same author, on the Use of Nitrate oj Silver, for the Detectivn of Arsenic, &c.
The supposed ambiguity of the operation of this valuable test is here very effectually obviated by Dr. Marcct. We believe, however, that some of the modes of operating, described by the author of the test, Mr. Hume, would supersede the necessity of further examinations. If we recollect justly, i)r. Dzondi on Burns, 239 justly, that gentleman has recommended lime* to be joined to arsenic on some occasions; and, if the quantity be sufficient, we presume no soluble phosphate could interfere in a well-conducted experiment, in which arsenic is to be detected by silver.
Mr. Hume succeeded also with barytes, and other earths, to prepare the arsenic for the silver test. Indeed the process, first announced by him in our Journal for 1810, seems adequate to prevent any error: it consists in converting the arsenic into arseniate of potash, by means of nitrate of potash. Upon the whole, while the phosphates can be so readily decomposed by lime, we can most safely rely upon the silver test, the ammoniaco-nitrate of silver, as the best of all methods yet devised for detecting this poison.
Such are the contents of this large volume, to which, if ample justice has not been done in our Journal, 'we can only plead, in our defence, that neither diligence, nor expence in the selection of able hands, have been spared. Dr. Dzondi, in this small treatise, proves cold water to be the first, greatest, and most powerful, nay the only remedy, for preventing the most dreadful consequences in cases of, burns, if applied timely, and with perseverance. His conviction of its efficacy is partly founded on a multiplicity of experiments made on animals and on himself, and partly results from his most successful treatment of very important cases; he ^also attempts to prove it a priori.
The first physical effect of a heat exceeding more or less SO or 40? Fahr. on the organization is an expansion of the fluids contained in the [tseda] cellulosa. This condition admits of two principal gradations: in the first or lesser degree the fluids are only so much expanded as to produce an unnatural distension, but not any laceration in the structure of the solids, which though disturbed in their functions are not totally destroyed. The second degree of the physical effect of heat on the organic structure occurs, when the fluids are so much * Philosophical Magazine, 1812. expanded, expanded, as to produce a laceration of the solids wfiiich are mechanically destroyed when the heat volatilizes the fluids into a gaseous form, particularly in proportion as the penetration of heat is more sudden from its rapid increase. The physical disturbance produced on the organization is very analogous to that occasioned by contusion ; for, as in the latter, the solids are distended and lacerated, so are they in the former expanded by the force of the fluids contained ki the cellulosa, rarefied by heat, vvitli the exception only that the expansion and laceration produced in this case, is more general, penetrating, and intense; to which is to be added, the total volatilization of the fluids in the form of steam, vapour, or gas, and .the carbonization of the solids produced by the higher degrees. The similarity of the pain, the progress of the disorder, and the remedies to be applied, confirm the analogy. By the distension and lacerations of the solids containing the fluids rarefied by the heat, a sensible pain is produced, or, in other words, an irritation in the nervous system, causing an exalted activity of the organic structure, and, of course, an increased influx of blood. This is principally in the capillary vessels in which every inflammation lakes its origin, inflammation being nothing else but an exalted activity of this system, caused by an unnatural irritation and producing new and irregular effects.
If, therefore, this violent irritation is not instantly removed, an inflammation of a peculiar character takes place.
The most important peculiarity of this inflammation, besides its long continued sensible pain and the copious secretion of lymph, is doubtless its violent operation upon the whole nervous system, and the reaction caused by it; as no other local irritation seems to produce such a sensible and painful stimulus, nor more obstinately resists every remedy. The violent commotion in the nervous system appearing in the form of a symptomatic fever is only the extension of the local inflammation over the whole nervous system, which particularly suffers so intensely, because by the violent operation of the heat, the nerves of the part burnt are so lacerated in their inmost texture, that the most sensible pain and an unceasing irritation is spread over the whole, not to be perfectly overcome by opium, bleeding, or any other remedy, till the local stimulus is deprived of its irritative power, by the only efficacious remedy in this case, viz. the The lower stage takes place when heat operates so slightly tipon the surface of the body as to produce a painful irritation, increased influx of the fluids, heat, redness, and an inconsiderable swelling, without any encreased secretion of! lymph in the cellulosa. Nature in this case, by means of her exertion to remove every unnatural obstacle, soon restores the equilibrium in healing this inflammation, as soon as the irritation of the nerves and the roused activity of the plastic system subsides, without the assistance of art, or any general reaction of symptomatic fever, except in very tew cases, and then but trifling.
In the second stage the irritation of the burn continues long enough to cause an enormously increased activity in the nervous system, and still more of the exhalent vessels of the skin, which shows itself by the secretion and excretion of lymph. A blister filled with an aqueous fluid is raised, which without bursting soon dries up, or, on being opened, heals by exsiccation, and the forming of a new epidermis without suppuration. The inflammation raised is similar to that of the serous membranes. In case the surface of the skin is deprived of its epidermis, it forms analogous to the serous membranes in an inflammatory state, exudations of lymph, which adhere to similar neighbouring organs.
In the third stage the heat has produced its effect, so long and so violently as not only to affect the exhalent vessels, but also the fibrous structure of the skin, causing an inflammation of the same, which in suppuration and cicatrization follows the course of inflammation in the serous membranes, but is aggravated partly by the pain still continuing, and partly by the greater quantity of lymph, which, at first in particular, is still secreted with the pus.
A complete destruction of the organic forms, by a degree of heat, which, by its violence and duration, not only^ expands the fluids in such a manner as entirely to dissolve, lacerate, and disorganize, the solid parts, establishes the fourth stage ; which* if the destroyed structure of the solids, by the partly remaining, but altered, fluids are kept in a state of softness, leads to a gangrene ; but, if the too great degree of heat has volatilized them, to a sphacelus. Different as the three last stages are with regard to local, they are similar with respect to the general, disturbance they produce in the constitution, which is frequently tar more dangerous than the local. The general symptoms are those of fever, viz. heat, rigor, restlessness, head-ache, thirst, spasms, altered pulse, convulsions, delirium, and often death.
The danger depends on the degree of heat, its duration; the tenderness and sensibility of the organ or of the constitu-.
3U. li tipn Crit icai Analysis. tion in general, its habitual or accidental disposition at that period, the situation and position of the affected part, and its sympathies with contiguous or remote organs.
The inflammation caused by burns, has, like all others, if it finishes its full course, three periods.
The first is the phlogistic, the state in which the nervou9 system in general is unnaturally irritated by the pain from the violent expansion, and put into an inflammatory disposition from the very attempts of. the plastic system to preserve or restore the parts. The duration of this period is from a few seconds to an hour in proportion to the irritation, and the reaction roused by it. If assistance is procured at this period, all the consequences of the burning, be it ever so violent or extensive, may be prevented, unless, from the intensity of Heat, the organic parts are instantly and perfectly destroyed, or the application of heat is continued. However, this is only to be understood of local inflammation. When the violence of the irritation has caused a general inflammation of the nervous system, it runs on under the form of what is called an inflammatory fever, in three periods of three times seven days, and, if sufficient assistance is not given, often proves fatal in the seven days of the first period.
The second period in this as in every other inflammation, is the plastic or restorative attempt. In this period, the plastic vessels, urged by the violent irritation, secrete an unnatural fluid, which at first consists of a clear serum or lymph, but afterwards, according to the difference of the inflamed organ, may be partly pus, lymph, or phlegm, &c. ; But, in deeply penetrating burns, is always pus, in consequence of the fibrous structure of the organ being attacked.
In its regular course, the injured surface is not so considerable as to require a longer time for the formation of the epidermis, three times seven or nine days is the period in which cicatrization takes place, and the formation of the dry scurf, if not prevented by art, is performed. The fever rarely attends this second period of inflammation. ' The third period, that of the crisis, comprises in this kind1 6f inflammation, the duration of the adhesion of the scarfskin to the injured part till the scar is formed; and in the regular course usually takes up from seven to nine days; Which period, however, may be shortened or lengthened by the activity or tardiness in the functions of the organism. In forming our prognosis of the possibility and degree of recovery of the injured part, regard must be had to the following points 1. T? Dr? Dzbndi on Burns.
1. To the degree of heat.?The lower the same, the more favourableUnder otherwise similar circumstances.
2. The duration of the operation of the heat upon the organism,?A less degree of heat operating for a longer time will produce a far more disadvantageous disturbance than a higher one operating upon the same part for a shorter time, as by the longer continuance of the irritation the nervous system is shaken in its inmost forms, [The sympathy i? more violent and more universal.} 3. The kind and nature of the vehicle of heat, 4. The condition of the local injury.?The more sensible the organ, the greater the danger; the larger the extent of the burn, the more important are the attending circumstances, and the worse dangerous consequences to be apprehended.
5. The general disturbance of the nervous system is, in most cases, of still more importance than the local injury.?t The more violent its reaction, such as fever, spasms, &c. the more dangerous the case.
6. Under perfectly similar circumstances, every thing depends upon the period of the inflammation, or the length of time elapsed since the moment of the burn taking place.-*. Every important disadvantageous consequence may be prevented, and in most cases, at least in ail those of the three first degrees, the injury can be perfectly repaired, be the latter ever so violent, provided no considerable destruction of the nobler organs has been occasioned, if assistance is procured in the first minutes after the accident. 7. In the prognostic, regard must be had to the exterior circumstances of the patient.
Appropriate Method of Healing Burns. The only and proper remedy to the application of which both nature and instinct lead us, is the opposite extreme, viz, cold, which, applied betimes and with perseverance in a sufficiently high degree and fit vehicle, has such a general vigorous effect as speedily to obviate every local and general consequence and effect of heat, complete disorganization only excepted; so that in the course of a few hours it establishes a perfect cure.
The best vehicle for the cold is water, an article to b? procured every where, speedily, and in abundance, besides its being, With respect to form and application, the most convenient, easily to be kept in the requisite degree of temperature, as easily modified and renewed, deserving of recompiendation; in short, the best, the readiest, and the cheapest, for the water to produce its full effect, it ought to be ap-\ i 2 i j>li$4 244 Critical Analysis. " plied in the very first stage, that is to say, when the reaction roused by the heat, has not as yet produced any unnatural secretion of ivmph, and it is only at this time that all and every consequence of burns can be prevented. Even, when by the violence of the heat the cuticle is instantly raised, if cold is directly applied, it will not suppurate, but dry up ; and the scab, after remaining about twenty-one days, will fall off; if cold is not applied in the very first stage of inflammation, the extent of that process will be progressive. In the beginning of the second period, the cold will still be of essential service, by removing in a few minutes all pain, and in a few hours every ill consequence, except the blister* ing, which will disappear as soon as a new epidermis is formed; if the blisters are already burst, and the surface of the skin secreting the lymph lies bare, the cold will not only speedily remove all pain, but put the bare surface in a few hours in a condition that a new epidermis will be produced within twenty-four and forty-eight hours, without any secretion of lymph; even several hours after the accident, and in general, as long as any pain is felt in the injured part, the application of cold is of benefit in stopping the effusion of lymph, and changing the burn into a common wound. If the pain has already fully ceased, the application of cold is superfluous, if not hurtful.
With respect to the duration of the application, the general, rule is to continue it as long as any pain is felt in the injured part; of course, it must be different in proportion to the violence of the heat and the disturbance thereby occasioned; we must not, however, be deceived by a freedom from pain for a quarter or even half an hour, or a whole hour, nor excite it again by motion, warmth, or irritating inhuence the patient must rather be kept quiet, cool, and avoid every irritation. With respect to the degree of cold to be applied, it is sufficient to take the feeling of the patient tor a guide. It the pain gives way to the cold, it is sufficient in degree ; as soon as the pain returns, the degree of cold mu.st be increased. A too low degree of cold, for instance, that at or near the freezing point, would be noxious, and on large surfaces, such as the abdomen, produce a bad effect upon the intestines. In most cases, a cold of 12? Ream, seems to be sufficient.
The best and most convenient way of applying cold water is the local or general bath ; less suitable are fomentations or pouring the water upon the injured part, these methods being troublesome on account of the necessity of frequent changes, though they are unavoidable in burns of the face and head. However, the fomentations and the pouring of ' ' the Dr. Dzondi on Bufrns. 245 the water, if used, must be continued without any Intermisrsion, so that the pain may not return for a single moment. Burns in the mouth are treated by taking repeatedly cold water into the mouth ; those of the throat, by frequent drinking and fomentation. The bath must be kept cold by a frequent change of water. The patient must avoid a pendant posture of the injured limb, be kept quiet, and only drink a cooling beverage. If this method of treatment is timely adopted, every other remedy may be quite dispensed with, and the open wounded and destroyed places be managed like common wounds. The suppurating and burned spots must .not be dressed with any irritating salve or ointment, but only with pure linseed oil, kept warm, and care be taken to prevent adhesion of the parts.
This may be sufficient for the local injury. If the inflammatory affection of the nervous system should require a particular treatment, it can be no other than the antiphlogistic. As a pure suffering of the nervous system is tne object, narcotic remedies, and particularly opium in large doses, will be the best antiphlogistic. Should the dose given not produce any effect, and.the pain still continue, it must be speedily enlarged, particularly with children. With robust plethoric persons, bleeding and the whole antiphlogistic method may be adopted.
The fever, in the succeeding periods, may be treated quite in the manner of a pure inflammatory one.
The question, In what manner the cold performs the healing of the burh ? Mr. D. endeavours to solve in the following manner:? The cold, if it operates in continuation, (not momentarily,, for then it encreases action,) has a double effect on all organic bodies; it deprives them of a part of this caloric, lessening thereby their distension, increases the contraction, and of course brings the parts into closer contact. In this manner it removes the too great warmth of the burnt part, lessens the unnatural distension and pain, increases the connection of the parts, contracts the vessels and the cellulosa, prevents the accumulation of the fluids, and thus operates ii^ opposition to the heat.
The second effect of the cold, partly resulting from the former, consists in a partial or total suppression of the vital activity ol the organism, or that part on which it operates in particular. The cold at the same time reduces the sensibility and activity of the nervous system, and thus also alleviates the pain.
The violence of a preternatural irritatioi* of the nervous. systeth 24 6 ?? Critical Analysis, " system stands in an opposite proportion, with "the duratioft of the same. Every reaction is most violent in the beginning, and, like the vibrations of a touched chord, gradually decreases in force, till it is entirely lost, and the original state returns again. If, therefore, the cold water removes the irritation for a sufficient length of time, the new and increased action of the vessels disappears of itself, and inflamw mation with it, as there can be no inflammation without an irritative cause.
The recovery of the sound condition, the formation of a new epidermis under the dried scurf, as also the removal of the latter and the formation of the scar, are only to be accounted for by the general organic poiver of nature, and the general vital principle.
The above article, received from our German correspondent, we Jose no time in inserting, though we have uot had an opportunity of perusing the work.
The most important part is the unreserved recommendation of cold wafer perpetually renewed at the common temperature. This ?we gi ve on the authority by which we receive it, only adding, that we have never found any inconvenience from cold application after these accidents. The directions for the temperature are simple enough, depending entirely on the sensations of the patient. If the water is too cold, it will soon be raised by contact with the injured surface to the wished-for temperature; and when it cxct^eds it, which will be known by the same test, the water should be agitated, and, if necessary, fresh added.
There arc two important omissions in that paper as we have re. ceived it : first, the danger of scalding or burning a considerable part of the skin, however slightly, and, however slight the imme. diate effects may seem, though it may be fairly surmised from paragraph 4, p. 243j is not impressed with sufficient force; next, the cautions against the contraction of the granulations, and the subsequent union of parts which ought to remain separate, as two fingers, or the neck with the chin, is not sufficiently dwelt upon.
But we have inserted the paper as soon as we received it, that wfe might not for a moment withhold the advice given at a'period wheb the most important remedy is probably the only one at hand.?Ed.
Edinburgh Medical and Surgical Journal, No. XLVII. for July, 1816. ' Art. I .?-Observations on the Utility of Blood-letting as the principal Remedy in Continued J'ever ; with some Cases of an Epidemic, in which it was practised with uniform and remarkable Success. By John Allan, Surgeon, Royal Navy. Another proof of tbe advantage of blood-letting. Though practical knowledge is the most important yet an attention to 24? causes is often not less necessary, in order to teach us the means of prevention.. " At the time (says Mr. Allan) that the disease which gave occasion for these remarks made its appearance, the ship had been about three weeks in Portsmouth harbour, and we afterwards regained there about five, that is, altogether, from the middle of April to the beginning of June last; during which period a certain number of the men were daily on shore on leave, an indulgence at, tended, as usual among sailors, with various excesses, especially frequent intoxication. It was, however, in very few instances, that the disease took place immediately after the application of these causes; for, though a few cases did occur early in the month of May, while we remained in the harbour, the greatest number, and some who had the most severe attacks, were not taken ill till several weeks after we had left that situation; and, indeed, we were scarcely without one or more eases of fever on the sick list till after the middle of August. The disease, therefore, must have owed its origin to some other cause besides the temporary irregularities just alluded to; and marsh miasmata, the most frequent cause of uncontagious fevers, appear, in this instance, to have been no less activc than usual. Our ship was so situated, during the time I have mentioned, as to be within forty or fifty yards of the extensive slimy mud-banks on the Gosport side of Portsmouth harbour, which are continually uncovered at low water, and from which, when the sun's rays were not interrupted by clouds, one might sometimes perceive exhalations rising in the form of a whitish Tapour.